{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:11:38Z","timestamp":1790244698695,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":266,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp;amp; Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the cost\u2010effectiveness of applying the Pediatric Emergency Care Applied Research Network (PECARN) head injury clinical decision rules versus usual care in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a public payer\u2010perspective decision tree model by comparing PECARN rule\u2010guided and usual\u2010care computed tomography (CT) strategies for children aged 0\u201315\u2009years with head injuries. The model captured short\u2010term pathways (clinically important traumatic brain injury [ciTBI], CT use, admission or discharge, and surgery) and lifetime radiation\u2010induced intracranial malignancy risk. Transition probabilities for the PECARN rule were obtained from a multicenter Japanese validation study, and usual\u2010care transitions and costs were estimated from the Japan Medical Data Center (JMDC) nationwide claims database (2012\u20132019). Life\u2010years were assessed over a lifetime. Uncertainty was explored using one\u2010way and probabilistic sensitivity analyses, and scenario analyses assessed parameters, facility type, short\u2010term hospitalization, and baseline CT utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base\u2010case analysis, the PECARN rule resulted in lower costs (\u00a511,391 vs. \u00a512,148) and slightly higher effectiveness (39.41303 vs. 39.41296 life\u2010years) than usual care. In probabilistic sensitivity analysis, the PECARN rule was cost\u2010effective in 99.98% of simulations at a willingness\u2010to\u2010pay threshold of \u00a55,000,000 per life\u2010year. CT rates among children without ciTBI influenced the net monetary benefit most. Scenario analyses showed that the findings varied by facility type and baseline CT utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In average hospital\u2010based usual care in Japan, use of the PECARN rule was associated with lower expected healthcare costs without meaningful loss of effectiveness and may support efficient resource use and reduced radiation exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ams2.70158","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:52:46Z","timestamp":1790243566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Rule\u2010Guided Head Computed Tomography for Pediatric Head Injury: An Economic Modeling Study Using a Nationwide Claims Database"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0586-5116","authenticated-orcid":false,"given":"Ryotaro","family":"Nagashima","sequence":"first","affiliation":[{"name":"Graduate School of Health Management Keio University  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8925-2348","authenticated-orcid":false,"given":"Satoshi","family":"Funada","sequence":"additional","affiliation":[{"name":"Health Technology Assessment Unit, Department of Preventive Medicine and Public Health Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8297-6988","authenticated-orcid":false,"given":"Yutaka","family":"Shigemori","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Faculty of Sports and Health Science Fukuoka University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Goto","sequence":"additional","affiliation":[{"name":"Graduate School of Health Management Keio University  Kanagawa Japan"},{"name":"Graduate School of Business Administration Keio University  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review","volume":"91","author":"Dewan M. 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